一种简化的手工缝制三叶瓣带瓣管道在右心室流出道重建中作为牛颈静脉移植物替代物的应用:单中心经验
Application of a Simplified Hand-Sewn Trileaflet Valved Conduit in Right Ventricular Outflow Tract Reconstruction as an Alternative for Bovine Jugular Vein Graft: Single-Center Experience.
作者信息
Zhang Hui-Feng, Ye Ming, Yan Xian-Gang, Chen Gang, Tao Qi-Lin, Jia Bing
机构信息
Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China.
出版信息
Artif Organs. 2018 Jan;42(1):41-48. doi: 10.1111/aor.12968. Epub 2017 Oct 2.
The Bovine jugular vein (BJV) graft for right ventricular outflow tract reconstruction (RVOT) is limited applied due to possible graft failure. In this study, we reported the clinical application of simplified hand-sewn trileaflet valved conduit as an alternative for BJV graft. We retrospectively included 68 patients underwent 76 conduits implantation including 22 new simplified hand-sewn trileaflet valved conduits (Group A) and 54 BJV grafts (Group B). For patients in Group A, a hand-sewn trileaflet valved conduit with valves made of autologous pericardium or expanded polytetrafluoroethylene was applied. Baseline, perioperative, and outcomes were analyzed. No early mortality or perioperative complication occurred in Group A, while 2 patients died and 16 patients suffered from conduits failure due to conduits stenosis (n = 11), stenosis plus regurgitation (n = 3), and regurgitation alone (n = 2) in Group B. Freedom from BJV grafts failure within 1, 3, 5, and 7 years was 98.0%, 88.2%, 83.6% and 83.6% in Group A, and 98.0%, 85.8%, 76.8% and 62.1% in Group B. Endocarditis occurred in 9 patients in Group B, but not in Group A. Subsequent analysis showed that endocarditis is the only significant predictor of BJV grafts failure (odds ratio: 6.202, 95% confidence intervals 1.237∼31.108). The novel simplified hand-sewn trileaflet valved conduits seems to be associated with lower incidences of perioperative complication, graft failure, and early-phase mortality, as compared with conventional BJV grafts.
由于可能出现移植物失败,用于右心室流出道重建(RVOT)的牛颈静脉(BJV)移植物应用受限。在本研究中,我们报告了简化手工缝制三叶瓣带瓣管道作为BJV移植物替代品的临床应用。我们回顾性纳入了68例接受76次管道植入的患者,其中包括22例新型简化手工缝制三叶瓣带瓣管道(A组)和54例BJV移植物(B组)。对于A组患者,应用了由自体心包或膨体聚四氟乙烯制成瓣膜的手工缝制三叶瓣带瓣管道。分析了基线、围手术期及结果。A组无早期死亡或围手术期并发症发生,而B组有2例患者死亡,16例患者因管道狭窄(n = 11)、狭窄合并反流(n = 3)和单纯反流(n = 2)出现管道失败。A组1、3、5和7年无BJV移植物失败的比例分别为98.0%、88.2%、83.6%和83.6%,B组分别为98.0%、85.8%、76.8%和62.1%。B组有9例患者发生心内膜炎,A组未发生。后续分析表明,心内膜炎是BJV移植物失败的唯一显著预测因素(比值比:6.202,95%置信区间1.237~31.108)。与传统BJV移植物相比,新型简化手工缝制三叶瓣带瓣管道似乎与围手术期并发症、移植物失败和早期死亡率的发生率较低相关。